This document discusses measuring adherence within PMTCT programs. It begins by defining PMTCT as a care and treatment program for pregnant HIV-positive women and their exposed infants, noting activities occur across antenatal care, maternity wards, exposed infant clinics and HIV treatment centers. Routinely collected data only provides a general idea of adherence. New tools are needed to assess adherence at different points, like antenatal adherence and infant follow-up. These tools should reflect PMTCT as a long-term program, not just delivery. Strong systems are required to retain families in care, like functioning appointment systems and linkage between services.
Addressing the Gaps in PMTCT Care - A Dr Besser Presentationmothers2mothers
- The document discusses the mothers 2 mothers (m2m) program, which addresses gaps in prevention of mother-to-child transmission (PMTCT) of HIV care through community health workers called Mentor Mothers.
- Mentor Mothers provide counseling, medication adherence support, infant feeding guidance, and psychosocial support to HIV-positive mothers at health facilities and through community outreach.
- Evaluation studies have shown that the m2m program improves PMTCT outcomes like increased HIV testing, antiretroviral adherence, exclusive infant feeding, and psychosocial well-being of mothers.
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
- The document summarizes Lesotho's national approach to rolling out more efficacious PMTCT regimens. It outlines key demographic data on HIV prevalence in Lesotho.
- It describes Lesotho's PMTCT services, including the introduction of revised guidelines in 2007 and the scale-up of services through training and decentralization. Coverage of PMTCT services increased gradually from 16.5% to over 70%.
- Challenges included staff rotations, drug stockouts, and ensuring mothers properly use the Mother/Baby Pack to administer drugs if delivering at home. Recommendations focused on improving drug supply and encouraging facility deliveries.
The document discusses South Africa's PMTCT (prevention of mother-to-child transmission) programme. It notes that around 300,000 mothers need treatment each year, with transmission rates currently around 11% and a goal of reducing to 5% by 2011. Coverage of testing and treatment through public primary health facilities has reached 95%. Key players in PMTCT implementation include the government, donors, civil society organizations, and the private sector.
This document discusses guidelines for treating HIV in older patients, women, and perinatal transmission. For newly diagnosed older patients, it notes they often have a more severe disease course and shorter survival than younger patients. It recommends ART for all older than 50. For adherence in older patients, it recommends combining pill counts, self-reports, viral load checks, and refill records. For pregnant women, it recommends the same regimens as non-pregnant adults, and starting ART in the first trimester or delaying until 12 weeks depending on factors. It recommends ZDV for intrapartum transmission prevention and starting infant ART prophylaxis with ZDV within 6-12 hours of birth.
Primary health care outreach clinic and EPI meeenamu
The document discusses Nepal's Primary Health Care Outreach (PHC/ORC) program and National Immunization Program (Expanded Program on Immunization).
The PHC/ORC program aims to improve access to basic health services for rural households through monthly outreach clinics within half an hour's walk of populations. Services include safe motherhood/newborn care, family planning, and child health. In 2075/76, the program served 2.8 million people through 138,125 clinics.
Nepal's immunization program started in 1974 and provides vaccines to children and mothers. It has helped reduce mortality from vaccine-preventable diseases. The program initially provided BCG and DPT in 3 districts and has
The document summarizes the key changes in WHO's 2010 guidelines for preventing mother-to-child transmission of HIV (PMTCT), including recommending lifelong antiretroviral treatment (ART) for all HIV-positive pregnant women and more effective prophylaxis options. It outlines two approaches - Option A focusing on antenatal/intrapartum drugs while Option B continues treatment during breastfeeding. Proper implementation of the new guidelines could reduce transmission rates to below 5% and bring the world closer to virtual elimination of pediatric HIV.
Addressing the Gaps in PMTCT Care - A Dr Besser Presentationmothers2mothers
- The document discusses the mothers 2 mothers (m2m) program, which addresses gaps in prevention of mother-to-child transmission (PMTCT) of HIV care through community health workers called Mentor Mothers.
- Mentor Mothers provide counseling, medication adherence support, infant feeding guidance, and psychosocial support to HIV-positive mothers at health facilities and through community outreach.
- Evaluation studies have shown that the m2m program improves PMTCT outcomes like increased HIV testing, antiretroviral adherence, exclusive infant feeding, and psychosocial well-being of mothers.
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
- The document summarizes Lesotho's national approach to rolling out more efficacious PMTCT regimens. It outlines key demographic data on HIV prevalence in Lesotho.
- It describes Lesotho's PMTCT services, including the introduction of revised guidelines in 2007 and the scale-up of services through training and decentralization. Coverage of PMTCT services increased gradually from 16.5% to over 70%.
- Challenges included staff rotations, drug stockouts, and ensuring mothers properly use the Mother/Baby Pack to administer drugs if delivering at home. Recommendations focused on improving drug supply and encouraging facility deliveries.
The document discusses South Africa's PMTCT (prevention of mother-to-child transmission) programme. It notes that around 300,000 mothers need treatment each year, with transmission rates currently around 11% and a goal of reducing to 5% by 2011. Coverage of testing and treatment through public primary health facilities has reached 95%. Key players in PMTCT implementation include the government, donors, civil society organizations, and the private sector.
This document discusses guidelines for treating HIV in older patients, women, and perinatal transmission. For newly diagnosed older patients, it notes they often have a more severe disease course and shorter survival than younger patients. It recommends ART for all older than 50. For adherence in older patients, it recommends combining pill counts, self-reports, viral load checks, and refill records. For pregnant women, it recommends the same regimens as non-pregnant adults, and starting ART in the first trimester or delaying until 12 weeks depending on factors. It recommends ZDV for intrapartum transmission prevention and starting infant ART prophylaxis with ZDV within 6-12 hours of birth.
Primary health care outreach clinic and EPI meeenamu
The document discusses Nepal's Primary Health Care Outreach (PHC/ORC) program and National Immunization Program (Expanded Program on Immunization).
The PHC/ORC program aims to improve access to basic health services for rural households through monthly outreach clinics within half an hour's walk of populations. Services include safe motherhood/newborn care, family planning, and child health. In 2075/76, the program served 2.8 million people through 138,125 clinics.
Nepal's immunization program started in 1974 and provides vaccines to children and mothers. It has helped reduce mortality from vaccine-preventable diseases. The program initially provided BCG and DPT in 3 districts and has
The document summarizes the key changes in WHO's 2010 guidelines for preventing mother-to-child transmission of HIV (PMTCT), including recommending lifelong antiretroviral treatment (ART) for all HIV-positive pregnant women and more effective prophylaxis options. It outlines two approaches - Option A focusing on antenatal/intrapartum drugs while Option B continues treatment during breastfeeding. Proper implementation of the new guidelines could reduce transmission rates to below 5% and bring the world closer to virtual elimination of pediatric HIV.
The document summarizes Kenya's process of revising its joint ART/PMTCT guidelines. It discusses that guidelines were revised through a consultative process involving government, donors, partners, and academics. The revisions adopted Option A for PMTCT, increased CD4 thresholds for ART initiation, and updated infant feeding guidelines. Implementation of the new guidelines faced challenges including confusion during transitions and debate over infant feeding policies. Next steps include building health worker capacity, procuring adequate drugs, and implementing revisions by September.
This document discusses PMTCT (prevention of mother-to-child transmission) of HIV and the importance of male involvement. It notes that over 90% of pediatric HIV infections are from mother-to-child transmission. While PMTCT programs have reduced new pediatric infections from 520,000 in 2001 to 430,000 in 2008, only 55% of pregnant women and 68% of exposed infants received antiretroviral drugs for PMTCT in 2009. The WHO's 4-component PMTCT strategy and EGPAF's expansion of PMTCT programs internationally are also summarized.
Lessons learned from Brazil on HIV self-testing and pre-exposure prophylaxisCheryl Johnson
(1) Brazil has an estimated 781,000 people living with HIV/AIDS, with prevalence rates highest among key populations like men who have sex with men and transgender women. (2) Several PrEP studies have been conducted in Brazil to evaluate its effectiveness and uptake among high-risk groups. (3) The Brazilian Ministry of Health plans to make PrEP available for free nationwide by the end of 2016 as part of its efforts to control the HIV epidemic through combination prevention approaches tailored for priority populations.
Uganda has a high prevalence of HIV but lacks widespread knowledge of HIV status due to issues with traditional testing methods, such as lack of privacy and stigma. HIV self-testing (HIVST) has the potential to increase testing rates in Uganda by addressing these issues. However, considerations must be made around legal and policy frameworks to allow oral fluid rapid diagnostic tests and counseling other than in-person. Leadership from the Ministry of Health will also be needed to ensure quality assurance, supply chain management, and linkage to care for those testing positive through HIVST.
7. Tom Lewis Getting it right for pathology presentationPHEScreening
This document summarizes a presentation on the Getting It Right First Time (GIRFT) program and its workstream focused on pathology. GIRFT aims to reduce unwarranted variation in clinical care through data collection, identifying best practices, and promoting changes. The pathology workstream is led by four clinical leads and aims to measure current variability in pathology services, create a vision for the future, and test changes. Key activities will include collecting data through questionnaires and site visits to understand variations and identify opportunities for improvement.
This document provides an update on the Infectious Diseases in Pregnancy Screening (IDPS) Programme in the UK. It discusses the aims of the programme, which include enabling early detection and treatment of infections in pregnancy to reduce mother-to-child transmission. It summarizes screening activity data which shows high uptake rates of over 99% for HIV, hepatitis B, and syphilis screening. It also discusses efforts to improve laboratory quality, establish screening standards and outcomes data, and provide education resources to professionals and the public. Specific updates are provided on actions relating to HIV, syphilis, hepatitis B, and developing seamless maternal and neonatal pathways between screening and immunization programs.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
This document provides guidance on monitoring and evaluating programs that implement lifelong antiretroviral treatment (ART) for pregnant and breastfeeding women living with HIV and their infants. It recommends adapting current monitoring and evaluation systems to integrate prevention of mother-to-child transmission and ART monitoring. This will allow programs to better measure maternal retention on ART, health outcomes for HIV-exposed infants, and identify implementation challenges. The document distinguishes between routine monitoring, which provides essential reporting data, and enhanced monitoring for early implementation of new approaches like Option B+. Enhanced monitoring involves additional data collection to promptly recognize and address problems.
Nepal has made progress in reducing child malnutrition but still faces challenges in meeting global targets. Key national nutrition programs include growth monitoring of children under 2, promoting appropriate infant and young child feeding practices, managing acute malnutrition, operating nutrition rehabilitation homes, and controlling micronutrient deficiencies through iron supplementation, iodized salt consumption, and vitamin A distribution. Moving forward, Nepal aims to further scale up these programs through multi-sector collaboration to fully tackle malnutrition.
Jennifer Weiss presented on addressing maternal mortality in Malawi through maternal death audits. Maternal death reviews began in 2003 at district hospitals in Malawi and were expanded in 2013 to a more robust Maternal Death Surveillance and Response system. This system identifies and notifies facilities of maternal deaths to determine causes and how they may have been prevented. Facility-level audits in Nkhotakota District found that referrals from health centers, lack of clinician training, and laboratory capacity needed improvement. Community-level audits also began but faced challenges in discussing deaths due to tradition; education was needed to explain how audits could reduce mortality. Further integration of community and facility audits with follow-up actions was recommended
This document outlines the RMNCH+A framework in India, which aims to improve reproductive, maternal, newborn, child and adolescent health through an integrated approach. It discusses the problem statement, goals and targets, strategic interventions across the lifecycle from adolescence to reproductive years. These include adolescent health services, antenatal care, skilled birth attendance, essential newborn care, immunization, and family planning. The framework also covers health system strengthening, program management, priority actions in vulnerable areas, and partnerships to support RMNCH+A service delivery in India.
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
Primary Health Care Outreach clinics were initiated in 1994 to improve access to basic health services in communities. These clinics are run by auxiliary nurse midwives and paramedics from health posts and primary health care centers. Services provided at the clinics include antenatal and postnatal care, family planning, child health services, and health education. While over 1.5 million clinic visits were conducted annually, not all planned clinics were functional due to issues. Recommendations include resolving problems to ensure all primary health care outreach clinics are operational.
The Maternal and Child Survival Program (MCSP) is USAID's flagship $500 million, 5-year program aimed at ending preventable child and maternal deaths in 24 priority countries. MCSP works across the continuum of care from household to hospital on technical areas like maternal and newborn health, child health and immunization, family planning, nutrition, and more. It focuses on cross-cutting issues like quality, innovation, gender, and health systems strengthening. The program's goal is to support countries in increasing coverage of reproductive, maternal, newborn and child health interventions and closing innovation gaps to improve health outcomes for vulnerable populations.
This document provides an orientation on quality maternal health care services in Myanmar. It discusses the global and national situations regarding pregnancy and childbirth, highlighting key maternal and neonatal mortality statistics. It outlines Myanmar's progress toward achieving Millennium Development Goals related to improving maternal health. The document defines essential reproductive health services, including safe motherhood, post-abortion care, birth spacing, sexually transmitted infections/HIV, and adolescent reproductive health. It emphasizes the need for skilled birth attendance and emergency obstetric care to reduce maternal and newborn deaths. The document also discusses focused antenatal care and the basic and comprehensive emergency obstetric care services required.
Reproductive morbidity in a village of kathmandu (Journal Club)RAVIKANTAMISHRA
This study examined the prevalence of reproductive morbidity and health care utilization among women in Ramkot Village Development Committee of Kathmandu, Nepal. The researchers found that 72% of women reported experiencing some type of reproductive health problem. Specifically, 40.5% reported gynecological morbidity and 45.8% reported obstetric morbidity during pregnancy. However, 59.3% of women did not seek any treatment for their reproductive health issues. While the study identified high rates of reproductive morbidity, it was limited by its small sample size and exclusion of sensitive questions.
RMNCH+A strategy: Reproductive, Maternal, neonatal, child and Adolescent Health Gaurav Kamboj
This document provides an overview of the RMNCH+A strategy in India. It discusses the historical background and goals of reducing maternal and child mortality. The key challenges include operating the different components vertically and strengthening adolescent health. Major causes of maternal and child deaths in India are hemorrhage, sepsis, abortion for mothers and pneumonia, preterm birth and sepsis for under-5 children. The strategy aims to address these across various life stages through interventions like adolescent nutrition programs, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and newborns. It also discusses strengthening the health system to deliver comprehensive RMNCH+A services and monitoring progress.
Ghia Fdn overview-strategy update january 2017 (presentation resaved sept 14_...Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
This document provides demographic and health statistics for the state of Andhra Pradesh, India. It includes data on population, births, mortality rates, fertility rates, maternal and child health indicators, nutrition levels, and disparities in coverage. The statistics show that while coverage of services has improved, inequities persist across gender, residence, and wealth quintiles. Disparities in coverage of services like antenatal care, institutional delivery, and vaccination need to be addressed to improve reproductive, maternal, newborn, child and adolescent health in the state.
Improving the HIV Cascade if Services in VietnamMatt Avery
This document discusses using the HIV cascade framework to improve HIV services in Vietnam. It provides examples of HIV cascades from several provinces that reveal gaps where people are lost at each step from diagnosis to treatment. Rapid assessments in provinces are using the cascade framework to identify targeted interventions. While Vietnam has made progress in HIV treatment, over 50% still start treatment late. The cascade framework is a useful planning and evaluation tool to monitor how well people move through prevention, testing, and treatment services and to close leaks in the system through strategic investments.
This document summarizes a study on the use of Synagis (palivizumab) to prevent respiratory syncytial virus (RSV) infections in neonates. The study finds that administering Synagis only to high-risk neonates, such as premature infants or those with chronic lung or heart conditions, is most cost-effective. Administering Synagis to all neonates without considering risk factors would be too costly without clear evidence of reduced hospital admissions. The document recommends further research to determine if the benefits of administering Synagis to all neonates outweigh the increased costs.
The document summarizes Kenya's process of revising its joint ART/PMTCT guidelines. It discusses that guidelines were revised through a consultative process involving government, donors, partners, and academics. The revisions adopted Option A for PMTCT, increased CD4 thresholds for ART initiation, and updated infant feeding guidelines. Implementation of the new guidelines faced challenges including confusion during transitions and debate over infant feeding policies. Next steps include building health worker capacity, procuring adequate drugs, and implementing revisions by September.
This document discusses PMTCT (prevention of mother-to-child transmission) of HIV and the importance of male involvement. It notes that over 90% of pediatric HIV infections are from mother-to-child transmission. While PMTCT programs have reduced new pediatric infections from 520,000 in 2001 to 430,000 in 2008, only 55% of pregnant women and 68% of exposed infants received antiretroviral drugs for PMTCT in 2009. The WHO's 4-component PMTCT strategy and EGPAF's expansion of PMTCT programs internationally are also summarized.
Lessons learned from Brazil on HIV self-testing and pre-exposure prophylaxisCheryl Johnson
(1) Brazil has an estimated 781,000 people living with HIV/AIDS, with prevalence rates highest among key populations like men who have sex with men and transgender women. (2) Several PrEP studies have been conducted in Brazil to evaluate its effectiveness and uptake among high-risk groups. (3) The Brazilian Ministry of Health plans to make PrEP available for free nationwide by the end of 2016 as part of its efforts to control the HIV epidemic through combination prevention approaches tailored for priority populations.
Uganda has a high prevalence of HIV but lacks widespread knowledge of HIV status due to issues with traditional testing methods, such as lack of privacy and stigma. HIV self-testing (HIVST) has the potential to increase testing rates in Uganda by addressing these issues. However, considerations must be made around legal and policy frameworks to allow oral fluid rapid diagnostic tests and counseling other than in-person. Leadership from the Ministry of Health will also be needed to ensure quality assurance, supply chain management, and linkage to care for those testing positive through HIVST.
7. Tom Lewis Getting it right for pathology presentationPHEScreening
This document summarizes a presentation on the Getting It Right First Time (GIRFT) program and its workstream focused on pathology. GIRFT aims to reduce unwarranted variation in clinical care through data collection, identifying best practices, and promoting changes. The pathology workstream is led by four clinical leads and aims to measure current variability in pathology services, create a vision for the future, and test changes. Key activities will include collecting data through questionnaires and site visits to understand variations and identify opportunities for improvement.
This document provides an update on the Infectious Diseases in Pregnancy Screening (IDPS) Programme in the UK. It discusses the aims of the programme, which include enabling early detection and treatment of infections in pregnancy to reduce mother-to-child transmission. It summarizes screening activity data which shows high uptake rates of over 99% for HIV, hepatitis B, and syphilis screening. It also discusses efforts to improve laboratory quality, establish screening standards and outcomes data, and provide education resources to professionals and the public. Specific updates are provided on actions relating to HIV, syphilis, hepatitis B, and developing seamless maternal and neonatal pathways between screening and immunization programs.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
This document provides guidance on monitoring and evaluating programs that implement lifelong antiretroviral treatment (ART) for pregnant and breastfeeding women living with HIV and their infants. It recommends adapting current monitoring and evaluation systems to integrate prevention of mother-to-child transmission and ART monitoring. This will allow programs to better measure maternal retention on ART, health outcomes for HIV-exposed infants, and identify implementation challenges. The document distinguishes between routine monitoring, which provides essential reporting data, and enhanced monitoring for early implementation of new approaches like Option B+. Enhanced monitoring involves additional data collection to promptly recognize and address problems.
Nepal has made progress in reducing child malnutrition but still faces challenges in meeting global targets. Key national nutrition programs include growth monitoring of children under 2, promoting appropriate infant and young child feeding practices, managing acute malnutrition, operating nutrition rehabilitation homes, and controlling micronutrient deficiencies through iron supplementation, iodized salt consumption, and vitamin A distribution. Moving forward, Nepal aims to further scale up these programs through multi-sector collaboration to fully tackle malnutrition.
Jennifer Weiss presented on addressing maternal mortality in Malawi through maternal death audits. Maternal death reviews began in 2003 at district hospitals in Malawi and were expanded in 2013 to a more robust Maternal Death Surveillance and Response system. This system identifies and notifies facilities of maternal deaths to determine causes and how they may have been prevented. Facility-level audits in Nkhotakota District found that referrals from health centers, lack of clinician training, and laboratory capacity needed improvement. Community-level audits also began but faced challenges in discussing deaths due to tradition; education was needed to explain how audits could reduce mortality. Further integration of community and facility audits with follow-up actions was recommended
This document outlines the RMNCH+A framework in India, which aims to improve reproductive, maternal, newborn, child and adolescent health through an integrated approach. It discusses the problem statement, goals and targets, strategic interventions across the lifecycle from adolescence to reproductive years. These include adolescent health services, antenatal care, skilled birth attendance, essential newborn care, immunization, and family planning. The framework also covers health system strengthening, program management, priority actions in vulnerable areas, and partnerships to support RMNCH+A service delivery in India.
Important maternal and child health parameters to evaluate quality care for the special group. Includes MMR, IMR, SBR, PMR, NMR, PNMR, U5MR. Practical class for UG 4th sem
Primary Health Care Outreach clinics were initiated in 1994 to improve access to basic health services in communities. These clinics are run by auxiliary nurse midwives and paramedics from health posts and primary health care centers. Services provided at the clinics include antenatal and postnatal care, family planning, child health services, and health education. While over 1.5 million clinic visits were conducted annually, not all planned clinics were functional due to issues. Recommendations include resolving problems to ensure all primary health care outreach clinics are operational.
The Maternal and Child Survival Program (MCSP) is USAID's flagship $500 million, 5-year program aimed at ending preventable child and maternal deaths in 24 priority countries. MCSP works across the continuum of care from household to hospital on technical areas like maternal and newborn health, child health and immunization, family planning, nutrition, and more. It focuses on cross-cutting issues like quality, innovation, gender, and health systems strengthening. The program's goal is to support countries in increasing coverage of reproductive, maternal, newborn and child health interventions and closing innovation gaps to improve health outcomes for vulnerable populations.
This document provides an orientation on quality maternal health care services in Myanmar. It discusses the global and national situations regarding pregnancy and childbirth, highlighting key maternal and neonatal mortality statistics. It outlines Myanmar's progress toward achieving Millennium Development Goals related to improving maternal health. The document defines essential reproductive health services, including safe motherhood, post-abortion care, birth spacing, sexually transmitted infections/HIV, and adolescent reproductive health. It emphasizes the need for skilled birth attendance and emergency obstetric care to reduce maternal and newborn deaths. The document also discusses focused antenatal care and the basic and comprehensive emergency obstetric care services required.
Reproductive morbidity in a village of kathmandu (Journal Club)RAVIKANTAMISHRA
This study examined the prevalence of reproductive morbidity and health care utilization among women in Ramkot Village Development Committee of Kathmandu, Nepal. The researchers found that 72% of women reported experiencing some type of reproductive health problem. Specifically, 40.5% reported gynecological morbidity and 45.8% reported obstetric morbidity during pregnancy. However, 59.3% of women did not seek any treatment for their reproductive health issues. While the study identified high rates of reproductive morbidity, it was limited by its small sample size and exclusion of sensitive questions.
RMNCH+A strategy: Reproductive, Maternal, neonatal, child and Adolescent Health Gaurav Kamboj
This document provides an overview of the RMNCH+A strategy in India. It discusses the historical background and goals of reducing maternal and child mortality. The key challenges include operating the different components vertically and strengthening adolescent health. Major causes of maternal and child deaths in India are hemorrhage, sepsis, abortion for mothers and pneumonia, preterm birth and sepsis for under-5 children. The strategy aims to address these across various life stages through interventions like adolescent nutrition programs, skilled birth attendance, emergency obstetric care, and postnatal care for mothers and newborns. It also discusses strengthening the health system to deliver comprehensive RMNCH+A services and monitoring progress.
Ghia Fdn overview-strategy update january 2017 (presentation resaved sept 14_...Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
This document provides demographic and health statistics for the state of Andhra Pradesh, India. It includes data on population, births, mortality rates, fertility rates, maternal and child health indicators, nutrition levels, and disparities in coverage. The statistics show that while coverage of services has improved, inequities persist across gender, residence, and wealth quintiles. Disparities in coverage of services like antenatal care, institutional delivery, and vaccination need to be addressed to improve reproductive, maternal, newborn, child and adolescent health in the state.
Improving the HIV Cascade if Services in VietnamMatt Avery
This document discusses using the HIV cascade framework to improve HIV services in Vietnam. It provides examples of HIV cascades from several provinces that reveal gaps where people are lost at each step from diagnosis to treatment. Rapid assessments in provinces are using the cascade framework to identify targeted interventions. While Vietnam has made progress in HIV treatment, over 50% still start treatment late. The cascade framework is a useful planning and evaluation tool to monitor how well people move through prevention, testing, and treatment services and to close leaks in the system through strategic investments.
This document summarizes a study on the use of Synagis (palivizumab) to prevent respiratory syncytial virus (RSV) infections in neonates. The study finds that administering Synagis only to high-risk neonates, such as premature infants or those with chronic lung or heart conditions, is most cost-effective. Administering Synagis to all neonates without considering risk factors would be too costly without clear evidence of reduced hospital admissions. The document recommends further research to determine if the benefits of administering Synagis to all neonates outweigh the increased costs.
The document summarizes updates to PMTCT (prevention of mother-to-child transmission) guidelines from the WHO and DHHS. Key changes include initiating ART for pregnant women at a CD4 count of <350 cells/mm3, starting ART earlier in pregnancy to reduce viral load, and recommending combination ART or HAART as the preferred regimen over AZT alone. The rationale for these changes is the earlier initiation of HAART in non-pregnant adults, the timing of mother-to-child transmission both with and without breastfeeding, and the importance of effective regimens to reduce transmission and prevent resistance. Safety data now supports the use of 3-drug regimens during pregnancy.
Can Community Systems Strengthening Improve Health? A Literature Review MEASURE Evaluation
This literature review examines how community systems strengthening (CSS) relates to health systems and outcomes. It analyzes conceptual frameworks that define community structures, functions, and attributes. The review finds that CSS encompasses both formal and informal community-level institutions from government and civil society. Effective CSS interventions include enabling community participation, advocacy, and networks to improve access to quality health services.
Within integrative medicine “adherence” is more than ensuring patients remembering to take their medication. It's about adhering to a new lifestyle, exercise routine, ditching bad habits, incorporating a new nutrition plan (in addition to medication or supplement use). This slide show take a look at the differences between "patient adherence" and "patient compliance", areas of adherence, the consequences of non-adherence and what you can do as their healthcare professional.
This document discusses medication adherence and provides information on improving it. It defines medication adherence and discusses the burden of non-adherence, including economic costs and impacts on clinical outcomes. It describes factors that influence adherence, such as health system issues, patient factors, therapy complexity, and socioeconomic barriers. Effective interventions to improve adherence include simplifying regimens, educating patients, addressing beliefs, improving communication, evaluating adherence, and using team-based care approaches. Tools and resources are also provided.
This document summarizes a study on the impact of mentor mothers on adherence to antiretroviral therapy (HAART) among HIV-positive mothers in Kenya. The study found that 98% of HIV-positive mothers identified during the study period were started on option B+ treatment immediately. All 91 mothers were supported by mentor mothers and remained actively engaged in care. Partner testing increased 60% with mentor mother support. Mothers in focus groups reported reduced infections and less stigma with treatment. The conclusion is that involving mentor mothers can significantly contribute to eliminating mother-to-child transmission of HIV.
RSV is a common virus that can cause severe infections in high-risk infants. Synagis is a medication that can prevent RSV hospitalizations but is very expensive. RSV Logic is a clinical program designed to optimize outcomes and control costs for patients receiving Synagis through activities like clinical assessments, medication education, and 24/7 support from nurses and pharmacists. The program aims to ensure high-risk infants receive Synagis only when truly needed based on their individual risk factors and medical history.
Early diagnosis of HIV in infants is crucial because HIV progresses rapidly in infants and mortality is high without treatment. By age 1, one-third of infected infants will have died, and by age 2 half will have died. Early initiation of antiretroviral therapy (ART) in infected infants under 12 weeks of age can reduce mortality by 76% and HIV progression by 75%. The goals of early infant diagnosis are to identify infected infants before clinical disease develops so interventions and ART can begin. Diagnosis is typically done through RNA or DNA PCR testing of dried blood spots or whole blood samples at ages 6 weeks, 10 weeks, 14 weeks, and later intervals. Point-of-care testing using p24 antigen detection is also possible
The document discusses complex patient journeys and tools to impact them. It begins by defining key dimensions and inflection points of patient journeys. Dimensions include the healthcare, disease/therapy, and human journeys. Inflection points are moments where outcomes are predicted. Behavioral science and cognitive-behavioral therapy can be used to intervene at these points by addressing cognitive, emotional, and behavioral barriers. A case study examines using these tools to help appropriate diabetes patients initiate insulin injections by addressing a patient's needle anxiety through cognitive reframing and desensitization exercises.
This document discusses patient adherence to medical treatment. It begins by noting estimates that 30-50% of medicines for long-term illnesses are not taken as directed, representing a loss for patients and the healthcare system. Common myths about non-adherence are debunked, and it is argued that patients' perceptions of their illness and prescribed treatment strongly influence adherence. Effective interventions should aim to improve the fit between patients' illness beliefs and treatment recommendations by addressing concerns about necessity and potential adverse effects through clear communication and education.
HIV DALAM KEHAMILAN & PENATALAKSANAANNYA (WHO 2013)Indah Triayu
Dokumen tersebut membahas tentang HIV/AIDS dalam kehamilan dan penatalaksanaannya. Beberapa poin penting yang diangkat antara lain bahwa risiko penularan HIV dari ibu ke bayi dapat dikurangi menjadi kurang dari 5% dengan memberikan terapi antiretroviral untuk ibu hamil dan bayi baru lahir, serta menyusui dengan pengganti ASI. WHO merekomendasikan pemberian regimen TDF+3TC(FTC)+EFV untuk semua ibu hamil
This document discusses medication adherence, which refers to patients taking medications as prescribed by healthcare providers. Around 125,000 people die each year due to failure to take or improperly take medications. The document explores differences between adherence and compliance, statistics on adherence, factors influencing adherence, and the importance of adherence. It also provides a clinical case study of a patient with low adherence and the barriers and health impacts.
Story Elements an Early Elementary Lessonfpalmateer
This document defines and provides examples of the five basic story elements: characters, setting, problem, solution, and theme. It explains that characters are the people or objects in a story, while setting refers to where and when the story takes place. The problem is the situation the characters face, and the solution is how they resolve the problem. Finally, the theme or moral is the overall idea or lesson of the story. Examples are given for each element to illustrate common types found in stories. The reader is encouraged to look for these elements when analyzing any story.
This document discusses multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). It defines MDR-TB as tuberculosis resistant to at least isoniazid and rifampicin, and defines XDR-TB as MDR-TB additionally resistant to fluoroquinolones and injectable second-line drugs. It also discusses mechanisms of drug resistance development, clinical factors promoting resistance, testing methods, categories of antituberculosis drugs, and public health responsibilities regarding treatment and prevention of drug-resistant tuberculosis.
An audit examines processes and outcomes in intensive care to identify opportunities for quality improvement. It involves comparing objectives and reality by assessing structure, process, and outcomes. Auditing an ICU's performance is important for patient safety, professional development of staff, and efficient use of resources. Key indicators that should be audited include adherence to evidence-based practices for conditions like sepsis, ventilation protocols to prevent pneumonia, and checklists for procedures like central line insertion. Collecting data on adverse events through confidential reporting allows teams to learn from mistakes and standardize care processes. Implementing care "bundles" that group several evidence-based practices for a given condition can help improve outcomes more than single interventions alone. Regular auditing is essential for ongoing assessment and
This document discusses key performance indicators (KPIs) for measuring agile projects. It begins by defining metrics and KPIs, noting that KPIs should be tied to strategic objectives and have defined targets. It then discusses characteristics of good KPIs and provides examples of both traditional and agile KPIs related to time, effort, scope, and quality. The document cautions that too many KPIs can be useless and advocates keeping metrics simple. It also discusses challenges like cheating on metrics and provides tips for using tools and dashboards to effectively measure agile performance.
Integrating Family Planning Into CSHGP and MCH Programsjehill3
The document discusses integrating family planning into maternal and child health programs. It provides historical context and examples of how flexible funds have supported family planning integration. Specific strategies discussed include community-based distribution of contraceptives, increasing postpartum family planning access, mobile family planning services, birth spacing messaging, and integrating abortion prevention and post-abortion care.
The journey towards making elimination of mother to child transmission a real...HopkinsCFAR
The document discusses the journey towards eliminating mother-to-child transmission of HIV (eMTCT) and the contributions of clinical research. It outlines the burden of mother-to-child HIV transmission and the progress made through PMTCT interventions and clinical trials. Landmark trials in Uganda evaluated effective ARV regimens and extended infant prophylaxis, informing WHO guidelines. Ongoing research addresses challenges like adherence and retention through interventions like peer support groups. Further research on new drugs, testing approaches, and integration of services is still needed to achieve eMTCT goals.
Presentation: Results of National Adherence PHEicapclinical
1. Rwanda's national HIV prevention, care, and treatment program has seen significant progress between 2004-2008, with HIV testing rates, ART coverage, and health facility participation all increasing substantially.
2. While barriers to PMTCT participation like fear of testing positive and partner disclosure remain challenges, programs have addressed issues like breastfeeding support and improving ANC attendance.
3. Clinical outcomes of ART have been positive, with high retention and adherence rates and significant CD4 count increases showing the effectiveness of treatment. Continued decentralization and integration of services is planned to further improve coverage.
Organizational Overview and Strategy - March 2016 UpdateGHIAFoundation
The GHIA Foundation was established in 2013 to improve women's health in developing countries post-2015. It focuses on strengthening health systems to deliver comprehensive services for maternal health, breast cancer, and cervical cancer screening and treatment. Key strategies include leveraging antenatal care platforms and training community health workers. The foundation implements programs in Liberia and Swaziland, training health workers and increasing cancer screening. Its long-term goals are to increase awareness, reduce maternal and cancer mortality, and build partnerships to strengthen national health systems for women's health.
The document outlines key strategies for improving maternal health in India, including using the Mother and Child Tracking System (MCTS) to ensure early registration of pregnancy and full antenatal care, detecting and line listing high-risk pregnancies like severely anemic mothers to ensure management, and equipping delivery points with facilities for basic and comprehensive obstetric and newborn care available 24/7. It also discusses reviews of maternal, perinatal and child deaths to understand gaps in health services and strategies to strengthen health infrastructure for maternal and newborn care.
The Mother and Child Tracking System (MCTS) is an initiative by the Government of India to monitor the health of pregnant mothers and children under 5 years old. The goal of MCTS is to reduce maternal and infant mortality rates by ensuring mothers receive antenatal care, delivery assistance, and postnatal care, and that children complete their immunizations. Health workers use MCTS to register pregnant women and newborns, send alerts on upcoming health services, and track the services received to strengthen health outcomes. Over 1 crore pregnant women have been registered under MCTS so far.
Presentation1 on Reproductive & Child HealthShan Damrolien
The Reproductive & Child Health Programme was launched in 1997 to integrate and strengthen existing family planning and child and maternal health services. The program aims to provide high quality, client-centered care to improve reproductive health. Key strategies include upgrading facilities, increasing access to obstetric and newborn care, treating reproductive tract infections, and encouraging community participation through local organizations. The second phase of RCH, launched in 2005, focuses on increasing institutional deliveries and emergency obstetric care through training and infrastructure improvements. Progress is monitored using indicators like antenatal care coverage, immunization rates, and access to treatment for common childhood illnesses.
This document discusses strategies for improving prevention of mother-to-child transmission (PMTCT) of HIV programs beyond 2010. It notes that while progress has been made, many challenges remain as only 55% of pregnant women receive PMTCT drugs and 68% of exposed infants receive them. Improving completion of the PMTCT "cascade" from testing to treatment is critical to reduce transmission rates. The document calls for global action including expanding programs, strengthening health systems, and integrating PMTCT with other maternal and child health services to work towards eliminating pediatric HIV.
Supporting Scaled-up Option B Plus in Malawi, Africa,
It was great to work with great scientists and to be part of this publication. Congratulations Team!
The National Family Welfare Programme was launched in 1952 to promote family planning and improve quality of life. It aims to encourage small family sizes and use of spacing methods. Key strategies include integrating family welfare services with health services, focusing on rural areas, and using mass media campaigns. The programme monitors indicators like contraceptive use, antenatal care coverage, and immunization rates. Maternal and Child Health programmes were also launched to reduce mortality and morbidity rates by providing reproductive health services, nutrition programmes, and disease prevention.
Focused antenatal and emergecy obstetric carePave Medicine
Focused antenatal care (FANC) aims to provide goal-oriented and timely care during pregnancy through a limited number of focused visits. The document outlines the elements and purposes of FANC, including early detection and management of diseases, individual birth planning, and 4 scheduled antenatal visits. It also discusses emergency obstetric care (EmOC) and the need to address barriers to access such as delays in seeking, reaching, and receiving appropriate care. A study in northern Tanzania found low availability of basic EmOC units, high availability of comprehensive EmOC units, and that 36% of expected deliveries occurred in EmOC facilities, above the minimum threshold of 15%.
Swot analysis of Safe motherhood, HIV & AIDS, ARI and Logistic Management Pro...Mohammad Aslam Shaiekh
The Acute Respiratory Tract Infection (ARI) program in Nepal aims to reduce childhood mortality from pneumonia through early diagnosis and treatment. The program trains female community health volunteers to diagnose pneumonia in children under 5 using an ARI timer and treat cases with antibiotics. It also educates mothers on the differences between cough/cold and pneumonia and the need for referral. While the program has increased access to care, analysis found low coverage of treatment at health facilities and by community health workers, suggesting the need for improved case management and coordination between levels of care.
PRINCIPLES of antenatal And Preconception Kenya.pptxMishiSoza
The document provides an overview of antenatal care (ANC), including its historical evolution, objectives, components, and best practices. It discusses factors that influence ANC attendance and adequacy. The key components of ANC include risk assessment, physical exams, basic investigations, nutrition counseling, and fetal assessment. ANC aims to maintain maternal and fetal health through monitoring, treatment, prevention, and health promotion. Focused ANC aims to achieve these goals through a minimum of four scheduled visits.
Elimination of mother to child transmission of hivstompoutmalaria
The document discusses eliminating mother-to-child transmission of HIV by 2015. It provides facts on the magnitude of MTCT, defines elimination as reducing the transmission rate to below 5%, and outlines the tools and costs required. These include ARV regimens, family planning services, and focused efforts in the 25 highest burden countries. Peace Corps volunteers could help implement prevention activities and promote services to measure progress towards elimination goals.
CORE Group Fall Meeting 2010. WHO/UNICEF - Joint Statement Service Delivery & Program Implications, - Winnie Mwebesa & Stella Abwao, Save the Children.
Improving follow-up and HIV testing rates of exposed infants through a suppor...3GDR
This document summarizes a study that aims to reduce loss to follow up in a mother-to-child HIV prevention program in South Africa by testing an intervention package involving enhanced care, SMS messages, and patient tracking. The randomized controlled trial will compare follow up rates to a previous study to determine if the intervention can significantly increase the number of mothers and infants receiving HIV test results. SMS messages will provide support, reminders and health information. Researchers hope to complete the study in early 2011 to evaluate the intervention's effects on retention in HIV care.
This document summarizes key topics in maternal and child health, including preconception health, prenatal care, delivery methods, postpartum care for women and infants, and emerging issues. It discusses strategies to improve outcomes like increasing access to reproductive healthcare and promoting breastfeeding. It also covers regionalized perinatal care, well-child visits, immunizations, safe sleep practices and social determinants of health. Emerging issues discussed include substance use in pregnancy, protecting women and infants' health in disasters, and the health needs of justice-involved women.
Make them count using the best data for maximum impactnewborn1
This document discusses indicators for measuring newborn health and mortality. It outlines progress made by various groups in establishing standardized indicators, including:
1. The Newborn Indicator Technical Working Group is working to establish core indicators for postnatal care, newborn behaviors, and newborn services in facilities.
2. The Countdown to 2015 initiative tracks coverage of interventions to reduce maternal and child mortality in 68 countries.
3. Core indicators are proposed for measuring kangaroo mother care in facilities, including the percentage of low birthweight babies receiving kangaroo mother care.
The goals of the workshop were to develop evidence-based strategies for improving, monitoring, and evaluating adherence support for HIV prevention, care, and treatment and to set a sustainable adherence agenda. The objectives were to review current adherence levels, share lessons learned and acquire new skills, identify strategies for improved monitoring and evaluation of adherence interventions, and develop country-specific work plans. Key topics included adult and pediatric care and treatment and PMTCT. Key adherence strategies to discuss were appointment systems, tracking patients, integrated counseling, peer education, and community linkages. The workshop would include presentations, breakout sessions, and action planning to help all ICAP sites implement functional appointment systems and counseling/assessment strategies by 2010.
This document summarizes issues related to pediatric adherence for HIV treatment in children and adolescents. It provides data on pediatric enrollment and adherence from ICAP programs in multiple countries. Key challenges to pediatric adherence are forgetting doses, staying away from home, and sleeping through doses. Developmental factors like age and disclosure status can also impact adherence. The document discusses strategies to support pediatric adherence, including education, reminders, involvement of caregivers, clinics that are child-friendly, and multidisciplinary teams. Country examples from South Africa, Kenya, and Ethiopia demonstrate approaches like appointment diaries, integration of services, and collaboration between medical and psychosocial teams to address children's developmental needs.
This document summarizes collaboration between ICAP Ethiopia and the Psychosocial Unit at Adama Hospital. The Psychosocial Unit provides psychological support for abused children, cares for abandoned children, and facilitates services for children in conflict with the law. ICAP and the Psychosocial Unit collaborate to meet the special needs of HIV-infected children enrolled in care at Adama Hospital, who face issues like orphanhood, mental health problems, child abuse, and homelessness. The multi-disciplinary team from both organizations provides psychological support, counseling, and medical support to referred children. This collaboration aims to establish a model pediatric psychosocial unit and expand services to other facilities.
Assessing Adherence to Treatment: A Partnershipicapclinical
This document summarizes a presentation on assessing adherence to HIV treatment. It defines adherence to care and treatment, describes various methods to measure adherence including patient recall, pill counts, and qualitative assessments. Program examples from Swaziland, South Africa, and Mozambique are provided. Visual, qualitative, and partnership-based approaches aim to facilitate patient understanding and ongoing monitoring to support optimal adherence. Barriers to implementation include staff time constraints and ensuring clinical interpretation and follow-up on assessment results.
Assessing Adherence to Treatment: A Partnershipicapclinical
This document summarizes a presentation on assessing adherence to HIV treatment. It defines adherence to care and treatment, describes various methods to measure adherence including patient recall, pill counts, and qualitative assessments. Program examples from Swaziland, South Africa, and Mozambique are provided. Visual, qualitative, and partnership-based approaches aim to facilitate patient understanding and ongoing monitoring to support optimal adherence. Barriers to and facilitators of adherence are identified to guide interventions.
Peer Educators for Adherence, Referral, and Linkages: The ICAP Rwanda Modelicapclinical
The document describes the PEARL program in Rwanda, which aims to enhance HIV patient adherence and linkages to care through peer education. The program trains and equips peer educators to conduct home visits and community outreach. It is implemented through local organizations in several districts. Peer educators provide counseling, referral, and psychosocial support. The program has strengthened services and reduced loss to follow up, though challenges include maintaining peer motivation and reaching mobile patients.
The document summarizes ICAP Tanzania's peer education program which aims to increase adherence and psychosocial support for people living with HIV. The program trains people living with HIV to serve as peer educators who provide counseling, health talks, and community outreach. Peer educators help 180 people across 35 sites and have established over 100 support groups. Evaluation found the program increased clients' adherence, reduced stigma, and improved tracing of patients lost to follow up. Challenges include a lack of health worker support and no formal policy to institutionalize the peer education role in health facilities.
GIPA/MIPA Principles and Adherence Support Programsicapclinical
GIPA/MIPA is a principle that aims to involve people living with HIV in decision-making processes that affect their lives and enhance the effectiveness of the AIDS response. People living with HIV have expertise from experiencing vulnerability to HIV and managing HIV-related illnesses. They can play important roles in advocacy, campaigns, policy-making, leadership, treatment programs, and personal health. Involving people living with HIV in these areas can help ensure community well-being, treatment scale-up, and universal access to HIV services.
Opportunities and Challenges to Adherence: A Field Experienceicapclinical
The document outlines the opportunities and challenges to adherence in prevention of mother-to-child transmission (PMTCT) programs in Rwanda. It describes the follow-up procedures for PMTCT women in the ante-partum, intra-partum, and post-partum periods. It also outlines the follow-up procedures for PMTCT infants in the intra-partum and post-partum periods. Lastly, it identifies opportunities such as the large proportion of clients tested for HIV and availability of CD4 count machines, and challenges such as the number of visits required and lack of reporting on refills and CD4 count indicators.
The Role of the Pharmacy in Adherence Supporticapclinical
This document discusses the expanding role of pharmacists in supporting HIV treatment adherence. It provides examples of how pharmacists in Cote d'Ivoire, Kenya, and South Africa work to enhance adherence through patient education, integrated appointment and pill count systems, visual analogue scales to assess adherence, and task-shifting some responsibilities to peer educators. The document also presents case studies demonstrating pharmacist interventions around medication counseling, drug interactions, pediatric dosing, and adherence barriers.
Clinical Systems Mentorship and Adherence: The ICAP Approachicapclinical
Clinical Systems Mentorship (CSM) is a methodology developed by ICAP that broadens the principles of clinical mentorship to public health programming and health systems strengthening. It focuses on continuous data-driven assessment, intervention, and re-assessment to implement high quality programs and build long-term capacity. CSM utilizes both "microskills" like interpersonal communication as well as "macroskills" related to implementation and quality improvement. The strategies employed by CSM change depending on the context and stage of development from start-up to maturity. CSM can be applied to adherence work by developing standards of care based on measuring and monitoring adherence, using data to prioritize issues, and ensuring interventions address the root causes in a
The goals of the workshop were to develop evidence-based strategies for improving, monitoring, and evaluating adherence support for HIV prevention, care, and treatment and to set a sustainable adherence agenda. The objectives were to review current adherence levels, share lessons learned, identify strategies for improved monitoring and evaluation of adherence interventions, and develop country-specific work plans. Key topics included adult and pediatric care and treatment and PMTCT. Key adherence strategies to be discussed were appointment systems, tracking patients, integrated counseling, peer education, and community linkages. The workshop would include presentations, group work, and action planning to help all sites implement functional appointment systems and counseling/assessment strategies by the end of 2010.
What Do We Know About Adherence in ICAP Programs?: A Review of the Dataicapclinical
This document summarizes adherence data from ICAP-supported HIV care and treatment programs in resource-limited settings. It finds that around 40% of patients were lost to follow up after 2 years of antiretroviral therapy, similar to other large ART programs. However, ICAP programs have high coverage of adherence support services like counseling, outreach workers, and patient tracking. The document calls for strengthening these services to improve long-term adherence and retention in HIV care.
Keynote – Framing Sustainable Adherence to HIV Prevention, Care & Treatment: ...icapclinical
This document discusses the importance of adherence to HIV treatment and challenges to achieving sustainable adherence. It notes that while high quality care is necessary, other factors like how patients internalize and use care in their daily lives are also important for good outcomes. Poor adherence can lead to negative individual and public health outcomes. Adherence is complex, multidimensional and needs to be maintained over a lifetime. The document calls for understanding adherence as both a clinical and psychosocial issue requiring a team approach and support programs sensitive to social and structural barriers patients face.
APS and Measurement (ICAP Annual Meeting 2007)icapclinical
The document discusses the importance of psychosocial support for patient adherence to HIV treatment. It suggests integrating psychosocial support throughout the continuum of care and measuring aspects of adherence support offered at facilities. Specifically, it recommends measuring the percentage of patients receiving counseling, adherence assessments, and support services. Measuring these adherence support factors along with patient-level adherence data would provide a more comprehensive view of programs and ways to improve patient outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Special issues for adherence in PMTCT Sara Riese, MIA, MPH PMTCT Program Officer Supporting Sustainable Adherence to HIV Prevention, Care & Treatment ICAP Technical Workshop October 19-22, 2009Kigali, Rwanda
2. Overview What do we mean when we talk about PMTCT? What about PMTCT adherence? What are some barriers to adherence in PMTCT programs? How can we measure PMTCT adherence? What activities and systems can help strengthen PMTCT adherence?
4. MTCT occurs during pregnancy, delivery and throughout the duration of breast feeding Early Postpartum (0-1 mo) Early Antenatal (<28 wks) Late Postpartum Labor and Delivery Up to 40% of transmissions can occur during breast feeding Late Antenatal (28 wks to labor) 1-6 mos 6-24 mos 0% 20% 40% 60% 80% 100% Proportion of infections
5. The possibility of mother-to-child transmission does not end at delivery, so our prevention activities must not end there!
6. Take home message: Re-conceptualize PMTCT PMTCT does not end at delivery There are 2 people involved (mother-child) Activities occur in different service areas (ANC, Maternity, Exposed Infant Clinic, Care and Treatment Clinic) Is a care and treatment program for pregnant HIV positive women that links them and their families into lifelong HIV care and treatment
7. Antepartum: PICT in ANC CD4 testing HAART Initiation AZT at 28weeks plus sd-NVP Partner Testing Intrapartum: PICT in L&D (repeat testing if prior negative test) CD4 Testing AZT/3TC tail FP Counseling AZT/NVP infant dose
8. i 1-8weeks post Partum: Maternal post partum follow-Up Enrollment into CTC FP Counseling PCR testing at 4-6weeks Growth Monitoring CTX initiation 2-6mos post partum: Repeat maternal CD4 (6mos post partum) Growth Monitoring CTX continuation IF counseling HIV infected infants: ART initiation/CD4 testing
9. 6-9mos post partum: Growth Monitoring CTX continuation Infant Feeding support 9-12 mos post partum: Growth Monitoring CTX continuation Infant feeding support Antibody testing: >3mos post BF cessation 12-18mos post partum: Antibody testing: >3mos post BF cessation Final infection status known Child discharged from PMTCT program
11. Food for thought: What is PMTCT adherence? If this whole spectrum of activities is the Package of PMTCT, then how would we define adherence to PMTCT? To PMTCT Care To PMTCT Treatment
12. Special barriers to consider for PMTCT Review of the existing literature on specific barriers to adherence for HIV + pregnant and post-partum women and their infants
13. Barriers to PMTCT Care adherence(PMTCT visits after positive test result) Fear of stigma and discrimination Lack of knowledge and understanding of PMTCT interventions Focus only on the infant, not on the mother Lack of spousal or family support Long wait times at ANC Associated costs Negative interactions with Health Care Workers Bwirire et al, Transactions of the Royal Society of Tropical Medicine and Hygiene , 2008 Meda et al, AIDS, 2002 Peltzer et al, African journal of Reproductive Health, 2007 Kebaabetswe et al, AIDS Care 2007
14. Barriers to PMTCT treatment adherence(PMTCT prophylaxis for mom and baby) Women Being away from home without medication Running out of pills Fear of mistreatment (especially for facility delivery) Non-disclosure/hiding medications Infants Not understanding how to give the syrups Being away from home Being busy Non-disclosure/hiding medications Kiarie, AIDS, 2003 Baek et al, Horizons Program Evaluation, 2009 Meda et al, AIDS 2002
15. Let’s look at the data Globally ICAP supported countries
16. Low rates of antiretroviral use for PMTCT in Sub-Saharan Africa Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, 10.2009
17. Percentage distribution of ART regimens for pregnant women Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, 10.2009
19. Proportion of HIV+ pregnant women with CD4 test results among 224 PMTCT sites, ICAP, April 2008-June 2009 Mean: average proportion of HIV+ pregnant women with documented CD4 result from April 2008-March 2009 vs. latest reporting, Apr-Jun 2009
20. Can we use routinely collected data to measure PMTCT adherence?
22. No. They only give us a general sense. These data do not tell us about one woman’s receipt of or adherence to care or treatment over time. They tell us how many individuals were documented to have received each separate intervention in the reporting period
23. The Pearl Study: NVP coverage cascade in HIV+ Women and their infants 3244 Number of women 1839 1590 Coetzee D et al. IAS, 2009, Abs. WeLBD101
24. Few ART eligible women initiated HAART in pilot in public clinic in Lusaka, Zambia 25% of HIV+ women identified in ANC received either prophylaxis or treatment Chi B, et al. JAIDS 2007 46% of eligible started treatment 65% of non-eligible received prophylaxis
25. Special Guest Presenters CanisiousMusoni ICAP Rwanda PMTCT Program Manager AruneEstavela ICAP Mozambique PMTCT Technical Advisor
26. Adherence and linkages workshop: Kgl Oct 09Using the routinely collected data from the URS to show the rates of HEI enrollment into HEI follow-up Canisious Musoni- PMTCT program manager
39. Peer Educators work with C H W/ leaders to remind women and children obey appointment schedules . Social events are usually used as forum to pass health messages
49. Need for improvement Harmonization of appointment schedules (eg vaccination and HIV follow up) Re - enforcement of prophylaxis , EID counselling messages right way from ANC till delivery especially for discordant couples Having an established M&E system that works with the rest of the units. In Rwanda, from e-data base, the data manager can easily retrieve the number of those missing their appointments. Then, worker or nurse can send PE out bring them back. Ownership of the program by health care facilities
50. Using data from the mother- infant pair tool Arune J. Estavela Adherence Technical Meeting Date October,19-22,09 Kigali, Rwanda
51. Background 20 millions inhabitants 16.0% HIV prevalence About 70% (~700/1000) of the MCH services offer PMTCT care ICAP support about 90 PMTCT sites in 5 provinces Between April to June 2009 (74 sites) 2809 HIV pregnant women 2382 exposed infant were registered at RCC (At Risk Children Consultation)
53. Expected visits during pregnancy 3rdANC 4 wks 4thANC 2 wks 5thANC 2 wks 1st ANC 2ndANC 1-2 wks Return to ANC and follow up Family Planning ART clinic visit Maternity Post partum visits Child health Exposed infant expected visits at specific follow up consultation 8 wks: PCR result: 4 wks of age: CTZ, PCR Monthly visits up to 18 months 2-7 days post partum ART Clinic or HEI follow up 4 wks: CTZ, PCR 4 wks: CTZ, PCR 4 wks: CTZ, PCR
74. How can our programs measure PMTCT adherence? Routinely collected data For a general idea Specifically designed tools to look at adherence at different points in the spectrum Mother PMTCT adherence tool PMTCT-CTC linkage assessment tool HEI follow-up adherence tool HIV+ infant-CTC linkage assessment tool Mother-Infant Pair tool
75.
76. Tools reflect the re-conceptualization of PMTCT Mother-Infant Pair Tool PMTCT does not end at delivery! Both mom and baby are involved Activities occur in different service areas (ANC, Maternity, Exposed Infant Clinic, Care and Treatment Clinic) Adherence assessments (Antenatal PMTCT and HEI follow-up) PMTCT as a care and treatment program for pregnant and postpartum HIV+ women and their exposed infants Linkage assessments (Antenatal PMTCT-CTC, HEI-CTC) Activities occur in different service areas (ANC, Maternity, Exposed Infant Clinic, Care and Treatment Clinic)
77. What is different about this new way of thinking about PMTCT? PMTCT does not end at delivery: Postpartum period is included in the PMTCT spectrum Multiple visits over time ART eligibility assessment and initiation during pregnancy and post partum period Linkages between service areas
78. How can we achieve it? Apply lessons learned from the ART roll-out Provide optimal biomedical interventions Create, develop and implement systems to retain women, their infants and their families in long-term follow-up Strengthen maternal-child health services Traditionally under-resourced health system for women and young children Attend to community and service delivery barriers
79. Priority Systems to put in place Functioning appointment systems which catch missed appointments and a system to track and trace patients Limited time during pregnancy Appts in different service areas Adherence assessments with a counseling framework
80. Other PMTCT-specific activities to consider implementing Psychosocial support for moms and families Strengthened linkage systems For mom For baby Between mom and baby Encouraging systems that reflect the vision of the PMTCT spectrum
81. Special Thanks to: Elaine Abrams Fatima Tsiouris Robin Flam Rosalind Carter All ICAP PMTCT Country programs
Editor's Notes
To start off, I want to make sure that we’re all thinking about PMTCT in the same way. PMTCT is a package of care services that starts during pregnancy and lasts all the way until the exposed infant has a final infection status and is discharged from the PMTCT program. This graphic shows all of the biomedical interventions that need to happen at each time period.
What are the take away messages from this PMTCT Care spectrum?We need to shift our thinking, reconceptualize what we mean by PMTCT.
Let’s review..What are some of the apss activities which would support adherence to these activities? Ask audience, give examples.Antepartum activities: Adherence counseling on PMTCT prophylaxis, targeted counseling for GA, support groups, peer educators, tracking and tracing plan that worksIntrapartum activities: Counseling during pregnancy on birth plan (where and how), apss support in labor ward for immediate postpartum support
Postpartum:For mom-support groups, especially around infant feeding and EID results, systems to ensure her engagement with CTC for her own healthInfant: systems that ensure follow-up in missed appts.
It is necessary that adherence and psychosocial support activities endure over a long period of time after delivery, not just in the immediate pp period
Now that we’re thinking about the PMTCT as this whole spectrum, a “package of care”, I’d like to hear your thoughts on adherence to this package. In looking at this spectrum, where do you think the biggest pt losses (in terms of ltfu)occur?One of the reasons why there are still so many children who acquire HIV from MTCT is because there has been a failure to implement this entire spectrum of interventions. But this spectrum does not reflect the psychosocial activities which must run parallel to the biomedical interventions in order to support the mother and her family to adhere to the entire package of PMTCT care and treatment.
There will be a more focused discussion on this topic during the concurrent sessions, but are there ideas for what would constitute adherence to PMTCT care? Care=appointments Adherence to care would mean that every woman tested HIV+ returns for all of the necessary follow-up visits.PMTCT treatment? Treatment=the appropriate prophylaxis or treatment as determined eligible for both mom and baby. Adherence to treatment would mean that every woman who initiates AZT prophylaxis or HAART during pregnancy is adherent to her meds, and that every infant given AZT syrup and CTX is given his/her meds appropriately.
In order to start thinking about what kinds of activities we need to implement in order to increase adherence, we need to consider the barriers.
(I’m going to insert the citations at the bottom)What are some of the barriers to adherence to PMTCT care (visits) that you have experienced in your countries?There is no data that I could find on barriers to follow-up visits during the postpartum period for HIV+ moms.
It is important to consider as well, that approximately 20% of PMTCT mothers should be eligible for treatment for their own health, so most if not all of the treatment barriers which we think about for adults on treatment would apply here as well.
Of the number estimated to be pregnant women living with HIV only 45% received any antiretrovirals for PMTCT and only 30% of estimated number of exposed infants were reported to have received treatment in 2008
Over time, the proportion of women getting a single antiretroviral for PMTCT is decreasing. This points to an increase in the proportion of women getting combination regmines, which means that we need to start thinking about how to keep women in care over time.
This shows the proportion of different prophylaxis regimens for PMTCT in ICAP countries.
This slide shows the proportion of HIV+ pregnant women with CD4 test results among 224 PMTCT sites reporting CD4 results in the past quarter as compared to the mean average over the previous year.If we include receiving CD4 test result in order to determine HAART eligibility as one of the activities on the spectrum which need to be done in our PMTCT package, then we can see that we are not achieving this. Far fewer than 100% of HIV+ pregnant women are getting their CD4 test results. Consider that ICAP has more than 600 PMTCT sites, and of those, only these 224 report having any CD4 test results on a pregnant woman.
Elaine: Tell me what you think of this slide. I got these #s from the URS for the past year (from last quarter back one year). I want to show a slide with many of the elements of the spectrum which are URS indicators in order to make the point that although it looks like we can follow a trend of adherence, really we cant. But if you think the #s look funny still, I can try and think of another way to do it.I CAN’T SPEAK TO THIS SLIDE AS I DON’T KNOW HOW THEY GOT THE DATA FOR MOST OF THE INDICATORS. I THINK TOO MANY WOMEN ARE IDENTIFIED HERE AS HAVING HAD A CD4 , ETC BUT YOU COULD SHOW IT AND QUALIFY THAT THE DATA ARE TAKEN FROM DIFFERENT PLACES AND ARE ILLUSTRATIVE.
Let’s look at how some studies have measured adherence in PMTCT:The PEARL study did an evaluation of adherence to sd-NVP, the minimum intervention for PMTCT. At each step along the cascade-with documentation and programmatic activities-women were lost and ultimately the intervention was not adhered to and only 49% of mother-infant couples received NVP.
A simple data collection instrument to abstract routinely collected mother and infant care information from facility registers (ANC and ARCC)The tool consisted of a single sheet, divided into mother and infact sectionAll variables registered ( patient charts) included routine antenatal care components as well as HIV care and treatment, partner testing and maternal post partum follow up
I deleted the data from Maputo. We can discuss about it before the presentation.55% of the mothers registered their babies at the infant clinic: show good linkages between services and good adherence to follow up.8 babies/11 (72%) had documented 6 weeks infant outcomes. 7/8 ( 87.5%) had PCR negative result and 1/8 (12.5%) had PCR result positive
So to review, how can our programs measure PMTCT adherence….
Best ways to measure adherence require going to the registers…and then feeding back information to the sites so that they can apply the information to their activities to improve
The toolsreflect this new approach to PMTCT that we’ve been exploring. The mother-infant pair tool looks one mom and her baby over the time that they should be receiving care and treatment and looks at adherence to the overall package for the mom-baby couple.And the other tools evaluate adherence to specific parts of the pmtct spectrum-prophylaxis for mom and baby, and linkages with the care and treatment clinics for both mom and baby. These tools go into more detail and can help identify at what point in, for example, prophylaxis provision in ANC, or at what point in the referral to CTC for an HIV+ infant, are we losing patients.BUT the tools only tell us how we are doing. They don’t tell us how we can achieve improved adherence.
In order to think about how we can actually improve adherence, let’s first review what is new and different a bout this new way of thinking about PMTCT?
We’ve encountered many of these same issues in the ART roll-out, and can apply many of the lessons learned from our experiences there to PMTCT.